Why We Train & Coach Clinicians in Communication Skills and Motivational Interviewing

This video was developed by the Veteran Health Administration (VHA)'s National Center for Health Promotion and Disease Prevention (NCP) to help VHA clinicians and leaders recognize the value of participating in NCP's patient-centered communication training. NCP developed two training programs to meet clinicians' needs: 1) TEACH for Success (TEACH), which features basic communication skills in health education and health coaching: and 2) Motivational Interviewing (MI), a clinical method for identifying and building patients' motivation to actively engage in self-care and health behavior change. VHA's TEACH and MI programs were specifically designed for VHA primary care clinicians providing care in Patient Aligned Care Teams (PACT), VHA's version of the patient centered medical home.

The patient-centered communication skills featured in TEACH and MI training enhance clinicians' capacity to provide personalized, proactive, patient-driven care (PPPDC). These skills include relationship-building skills (e.g., open-ended questions to explore patient needs, values and concerns; reflections, empathy, respect); health education skills (e.g., sharing information, teach-back), shared decision making skills, and health behavior counseling skills (e.g., evoking change talk, goal setting, problem-solving).

In addition to participating in face-face, experiential TEACH and MI courses, clinicians are offered opportunities to participate in follow-up clinician coaching to help them apply TEACH and MI skills in clinical encounters with Veterans. To disseminate TEACH and MI training and follow-up clinician coaching, NCP trains and supports over 300 active TEACH and MI Facilitators, who are also extensively trained to provide learner-centered clinician coaching. TEACH and MI facilitators/coaches also serve as VHA facility-based Veterans Health Education Coordinators (VHECs), Health Behavior Coordinators (HBCs) and Health Promotion Disease Prevention Program Managers (HPDP PMs), and work collaboratively with PACT teams to integrate TEACH and MI skills with other tools, resources and programs that support PPPDC. These tools and resources include: an online health risk assessment tool, goal-setting and decision-making tools, an online Veterans Health Library; and access to VHA and community-based programs in tobacco cessation, weight management, self-management and other health behavior change areas.Training and clinician coaching in TEACH and MI is a key component of PACT's "roadmap" for operationalizing PPPDC in primary care.

In the "Why Train" video, PACT leaders, PACT clinicians and Veterans share reflections about the value and impact of TEACH and MI training on Veteran experience, the quality of care and health outcomes. Clinicians also share how training and coaching has enhanced their skills, their  morale and even their overall satisfaction with their work!

It's Not Too Late to Make New Year's Resolutions

Just because it is already January 10th doesn't mean it is too late for New Year's Resolutions. See the link below to my Empowered Patient columnin the MPNforum for some ideas about how to make your New Year healthier.
http://mpnforum.com/michael-dec-17/

The Great American Smokeout - An Empathic Opportunity

Though any time is a good time to quit smoking,  November 15, 2012 is the 37th annual Great American Smokeout, or GASO, a day when hundreds of thousands of smokers will try to stay cigarette free.

Tobacco use remains the single largest preventable cause of death and disease in the United States, with approximately 443,000 U.S. adults dying from smoking-related illnesses each year!

 

The good news is that stopping smoking will provide some immediate health benefits. For example, your risk for having a stroke, heart attack or other cardiovascular event are reduced dramatically as soon as you quit smoking. Moreover, the risks of developing a smoking-associated cancer or other tobacco use-related condition also diminish over time.

 

Even if you don't smoke, someone you love may be a smoker and might benefit from quitting smoking during the GASO, or as a New Year's resolution, or any time!

 

So, what does this have to do with empathy and why am I writing about the Great American Smokeout here? 

 

Well, I can't help myself. As a physician, I have seen the ravaging effects that smoking has had on my patients and those who love them. As an educator, I have spent a good part of my career trying to help caring clinicians feel more prepared and confident about assisting their patients who smoke. And as a researcher,  I know that even a small dose of clinician empathy and a little advice and support improves smoking cessation outcomes.

 

So, if you are a smoker, take this opportunity to think about quitting. If you love a smoker, tell them you care about them and want to support them in their efforts to stay healthy. If you are a clinician, ask your patients who smoke if you can help them address their smoking.

 

The good news is that many forms of effective smoking cessation treatment, including medication, counseling and support, are now readily available:

• Medications reduce symptoms of nicotine withdrawal and improve rates of quitting. Some nicotine replacement therapies (e.g., patch, gum, lozenge) are available over-the-counter while others (i.e., nicotine inhaler and spray; bupropion; varenicline) are available by prescription;
• Behavioral counseling, alone or when provided with medication, improves quit rates. Counseling is provided in individual and group formats and also via free state-supported telephone quit lines; and
• Online quit programs and mobile aps also show great promise.

For quitting resources and more on the Great American Smokeout, go to the American Cancer Society page at: http://www.cancer.org/healthy/stayawayfromtobacco/greatamericansmokeout/index

For a wonderful Youtube video by Dr. Mike Evans on how to quit smoking see: http://www.youtube.com/watch?v=I0zvG2vSjrA&feature=share&list=PL9FF73EC555CB6855

And for addition quitting resources see the National Cancer Institute site at: http://www.cancer.gov/cancertopics/tobacco/smoking

Health Coaching: A Road to Empowerment

See my latest The Empowered Patient column in the October 15th issue of MPNforum. MPNforum October 15, 2012 - The Empowered Patient.

In the column, I share my personal experience with health coaching as well as my reflections about the qualities to look for in a coach. In sum, "Great coaches empower us by helping us to build the self-monitoring, self-assessment and problem-solving skills that we need to achieve long term success."

Several Recent Articles Stress the Value of Empathy in Medical Care.

The importance of empathy in medical care is the focus of several articles recently published in the medical literature. See below for a brief comment on each and a link or reference to the article.

In an article that appeared in the March, 2012 issue of Perspectives on Psychological Science, Hacque and Waytz include empathy reduction in clinicians as one of the "causes of dehumanization" in medicine. They suggest that clinicians have difficulty being empathic when actively engaged in demanding cognitive processes, such as diagnostic reasoning and problem solving. Empathy reduction can be countered, however, by strategies which promote clinician awareness of the human and emotional aspects of patient care, such as learning about the whole patient (e.g., interests, roles, values, preferences) and recognizing the dehumanizing aspects of medical settings, technology and the procedural elements of care. The article citation is: Hacque, OS, Waytz A. Dehumanization in Medicine: Causes, Solutions, and Functions. Perspectives on Psychological Science March 2012 vol. 7 no. 2 176-186. doi: 10.1177/1745691611429706                                 

In the May, 2012 issue of the Journal of General Internal Medicine, Helen Reiss and colleagues reported that training in empathy improves physician use of empathic skills. Reiss reports that providing three 60-minute empathy training modules to residents and fellows (physicians undergoing specialty training post medical school) produced significantly greater changes in a patient-rated measure of empathy than residents undergoing standard training. Trained physicians also showed greater changes in their ability to decode facial expressions of emotion. An abstract of the article can be found at: http://www.ncbi.nlm.nih.gov/pubmed/22549298

And, the most inspiring article of the recent articles was written by Bernie Lown, MD's on his personal blog. See: http://bernardlown.wordpress.com/2012/04/29/social-responsibility-of-physicians/ . Bernie is a renowned cardiologist, educator and researcher who has been a proponent of patient-centered care for 60 + years! Dr. Lown is a leading voice in medical ethics and social responsibility and was a recipient of the Nobel Peace Prize for his leadership of the Physicians for Social Responsibility during this organization's campaign to educate the public about the medical consequences of a nuclear catastrophe. He has also been an outspoken critic of overtreatment and
unnecessary use of medical technology, especially in advancing cardiovascular health,  and has emphasized the value of addressing health behaviors and promoting patient engagement and empowerment in his publications. The current article is a transcript of his address to the April, 2012 Avoiding Avoidable Care Conference held in Cambridge, MA. (See http://avoidablecare.org/ for more on the conference). Here is my favorite section:

Sixty years of doctoring has taught me that taking a history, namely listening, is the quintessential part of doctoring. Proper listening is a skill, an art and a core element of medical professionalism. History taking is far more than providing key elements for a diagnosis. It is the basis for nurturing trust. I am persuaded that nothing of science taught to medical students is as difficult to master as is the fine art of listening.

Top 10 Ways to Be More Empowered: New Post in MPNForum, April, 2012

My latest column in the April, 2012 issue of MPN Forum lists my top 10 strategies for empowerment. As I approach 60, I plan to employ these strategies to help me to stay well and manage my health conditions. I hope you will find them useful as well.

See Top 10 Ways to Be More Empowered

Lady Gaga Launches Foundation to Promote Tolerance, Acceptance and Empathy Among Youth

When you listen to Lady Gaga's pulsing music, see her striking photos, or watch her theatrical performances on video or TV, my guess is that empowerment and empathy are not the first things that come to mind. However, after learning about the launch of Lady Gaga's new Born This Way Foundation (BTWF) http://bornthiswayfoundation.org/, I am going to have a hard time not thinking about Lady Gaga's empathy whenever I hear Born This Way, the Foundation's anthem.

At a news conference held at Harvard University, Lady Gaga and her mother, Cynthia Germanotta, indicated that they started the Born This Way Foundation to promote youth empowerment and speak out against bullying. As noted on the BTWF website, the Foundation's mission is "to foster a more accepting society, where differences are embraced and individuality is celebrated." To achieve its mission, the Foundation is "dedicated to creating a safe community that helps connect young people with the skills and opportunities they need to build a braver, kinder world."

In an interview that appeared in Nicholas Kristof's New York Times column http://www.nytimes.com/2012/03/01/opinion/kristof-born-to-not-get-bullied.html?_r=2&src=me&ref=general, Lady Gaga describes being taunted, bullied and traumatized by fellow students during her high school years.  And, in an interview on the pop culture site, PopCrush http://popcrush.com/lady-gaga-launches-born-this-way-foundation/, Lady Gaga states that she has learned to respond to taunts with empathy...“I always have a moment of empathy.... I think they must be going through something today that is coming from a place of mental turmoil or a psychological challenge".

It would be wonderful if Lady Gaga can help stem the increase in youth bullying by promoting empowerment, empathy, tolerance and acceptance.

Motivating Yourself: A New Empowered Patient Column in the March MPN Forum

My latest post in The Empowered Patient column in the March, 2012 issue of MPN Forum features a strategy to help you break through the ambivalence that often keeps people for making important life changes.

So, if you are considering change, but have been unable to take action, it may be useful to ask yourself a series of questions that spur you to reflect upon about the value, importance and meaning of making the change. See below for some questions to help you to motivate yourself to take action. Reflect on  your answers and consider writing down your responses to the 3 questions that have the most meaning to you.

See the MPN Forum column (http://mpnforum.com/the-empowered-patient-march/ ) for more guidance about how to use these quesions to help move yourself towards action.

Questions for Motivating Yourself 

• What do I want to change?
• What reasons do I have for changing? (focus on your reasons, rather than somebody else's reasons)
• What is the most important reason for changing?
• What makes it so important?
• If I were able to change, what benefits would I experience?
• What is the most important benefit?
• Who else might benefit from my change?
• How would people who care about me feel about my change? (picture the scene)
• How would I feel about myself if I was able to change? (try to imagine actually experiencing the feeling)
• What small steps can I take to get started on the road to change? (consider the really really small steps that you know you to successfully take)
• Who can help me get started?
• How can I bring my talents and skills and experience to the change process?

New Post in MPN Forum - The Empowered Patient: New Years Resolutions

See the February issue of MPN Forum for the lastest The Empowered Patient column, New Year's Resolutions: A Road to Empowerment. MPN Forum: The Empowered Patient (Feb, 2012)

Though it may be difficult to keep New Year's resolutions several strategies may help you you stay on track. These include staying positive, setting achievable goals, learning from slips and rewarding small successes.